癌症患者发生静脉血栓栓塞(VTE)的风险是普通人群的4-7倍。癌症相关静脉血栓栓塞(CA-VTE),是癌症患者发病和死亡的主要原因。低分子量肝素(LMWH)历来是CA-VTE的主要治疗方法;然而,出血和复发性VTE等并发症使这些患者的治疗具有挑战性.最近的随机对照试验(RCT)已经证明,直接口服抗凝剂(DOAC)在治疗CA-VTE方面与LMWH一样有效。我们进行了系统评价和荟萃分析,以确定LMWH和阿哌沙班治疗CA-VTE的有效性和安全性。使用Medline进行了系统评价,Embase,还有Scopus,所有队列研究的数据库,病例对照研究,和英文RCT比较了从开始至2023年5月接受阿哌沙班或LMWH治疗以治疗CA-VTE的癌症患者。审查经理计划,版本5.4.1用于统计分析和Mantel-Haenszel固定效应模型,以计算风险比(RR)和95%置信区间(CI)以及逆方差方法,以获得连续结果的加权平均差。使用异质性的Q检验来检查统计异质性,I2统计值>50%被定义为显著异质性。共纳入四项研究,所有研究的患者总数为1,632例.阿哌沙班组与少量出血的统计学显著增加相关(RR1.57;95%CI(1.12,2.21);p=0.009;I2=0%),但不是大出血和完全出血。与LMWH组相比,阿哌沙班组的VTE复发风险显着降低(RR:0.61;95%CI(0.41,0.92);p=0.02;I2=7%),两组间死亡率差异无统计学意义(RR:0.89;95%CI(0.73,1.09);I2=0).我们的研究结果表明,阿哌沙班可能是治疗癌症相关血栓栓塞的有利抗凝选择。因为它显示了复发性VTE的风险较低。胃肠道肿瘤中DOAC出血的风险值得进一步研究。
Cancer patients\' risk of developing venous thromboembolism (VTE) is four to seven times higher than the general population. Cancer-associated VTE (CA-VTE), is a leading cause of morbidity and mortality in cancer patients. Low Molecular Weight Heparin (
LMWH) has historically been the mainstay treatment of CA-VTE; however, complications such as bleeding and recurrent VTE make it challenging to manage these patients. Recent randomized controlled trials (RCTs) have proven that direct oral anticoagulants (DOACs) are as efficacious as LMWHs in treating CA-VTE. We conducted a systematic review and meta-analysis to ascertain the efficacy and safety of
LMWH and Apixaban for the treatment of CA-VTE. A systematic review was conducted using Medline, Embase, and Scopus, databases for all cohort studies, case-control studies, and RCTs in English comparing cancer patients undergoing treatment with Apixaban or
LMWH to treat CA-VTE from inception-May 2023. The Review Manager program, version 5.4.1, was used for statistical analysis and the Mantel-Haenszel fixed-effects models to calculate the risk ratio (RR) and 95% confidence intervals (CIs) and the inverse variance approach to get the weighted mean difference for the continuous outcomes. Q-test for heterogeneity was used to examine statistical heterogeneity and an I2 statistics value >50% was defined as significant heterogeneity. A total of four studies were included, and the total number of patients was 1,632 across all studies. The Apixaban group was associated with a statistically significant increase in minor bleeding (RR 1.57; 95% CI (1.12, 2.21); p=0.009; I2=0%), but not for major and total bleeding. The Apixaban group showed a statistically significant lower risk of recurrent VTE when compared to the
LMWH group (RR: 0.61; 95% CI (0.41, 0.92); p=0.02; I2 = 7%), and there was no statistically significant difference in terms of mortality between the two groups (RR: 0.89; 95% CI (0.73, 1.09); I2=0). Our findings suggest that Apixaban may be a favorable anticoagulant option for managing cancer-associated thromboembolism, as it demonstrated a lower risk of recurrent VTE. The risk of bleeding with DOAC in gastrointestinal cancers warrants further investigation.